Electrolyte disturbance Flashcards
What are the signs and symptoms of hypokalaemia?
weakness, hypotonicity, ventilatory failure, hyporeflexia, cramps, tetany, palpitations, light-headedness, constipation, charactertistic ECG changes , dysarrhythmias if severe -> rhabdomyolysis may occur - muscle pain, swelling, tenderness and red-brown urine
What are the signs and symptoms of hyperkalaemia?
tingling, weakness, flaccid paralysis, chest pain, palpitatons, light-headedness characteristic ECG changes, cardiac dysrhythmias, hypotension
What are the signs and symptoms of hyponatraemia?
anorexia, nausea, malaise initially followed by headache, irritability, confusion, weakness, decreased GCS and seizures
What are the signs and symptoms of hypernatraemia?
lethargy, thirst, weakness, irritability, confusion, coma and fits along with signs of dehydration
What are the signs and symptoms of hypocalcaemia?
SPASMODIC Spasms - carpopedal spasms = Trousseau’s sign (on inflating cuff, wrist and fingers flex/draw together Perioral paraesthesiae Anxious, irritable, irrational Seizures Muscle tone increased in smooth muscle - colic, wheeze and dysphagia Orientation impaired and confusion Dermatitis - atopic/exfoliative Impetigo herpetiformis Chvostek’s sign (corner of mouth twitches when facial nerve tapped over parotid), Choreoathetosis, Cataract, Cardiomyopathy (long QT on ECG
What are the signs and symptoms of hypercalcaemia?
bones, stones, groans and psychic moans: abdominal pain, vomiting, constipation, polyuria, polydipsia, depression, anorexia, weight loss, tiredness, weakness, hypertension, confusion, pyrexia, renal stones, renal failure, ectopic calcification, cardiac arrest, ECG showing shortened QT interval
What are the signs and symptoms of hypermagnesium?
if severe: neuromuscular depression, hypotension, bradycardia, hyporeflexia, CNS and respiratory depression, coma
What are the signs and symptoms of hypomagnesium?
paraesthesiae, ataxia, seizures, tetany, arrhythmias
What are the typical ECG changes seen in hyperkalaemia?
flattening P wave, tall tented T waves, widening QRS complex and PR interval, development of deep S waves, sinus arrest with nodal rhythm, sine wave ECG pattern and asystole cardiac dysarrhythmias - ventricular ectopic beats, atrial arrest, atrio-ventricular block, ventricular tachycardia and ventricular fibrillation
What are the possible causes for hypernatraemia?
usually due to water loss in excess of sodium ions fluid loss without water replacement - diarrhoea, vomit, burns Diabetes insipidus - suspect if large urine volume, may follow head injury or CNS surgery especially pituitary osmotic diuresis primary aldosteronism - suspect if raised BP, low K and alkalosis (raised HCO3) Iatrogenic - incorrect fluid replacement
What are the possible causes for hyponatraemia?
If dehydrated with urinary Na >20 mmol/L = water+Na lost via kidneys
- Addison’s disease
- Renal failure - diuretic phase of renal failure, nephrocalcinosis or medullary-cystic disease
- Diuretic excess
- Osmolar diuresis - incr glucose, incr urea
If dehydrated but urinary Na < 20 mmol/L = water+Na lost other than via kidneys
- diarrhoea
- vomiting
- fistulae
- burns
- rectal villous adenoma
- small bowel obstruction
- trauma
- cystic fibrosis
- heat exposure
Not dehydrated with oedema
- nephrotic syndrome
- cardiac failure
- liver cirrhosis (hyponatraemia may preced oedema)
- renal failure
not dehydrated, no oedema with urine osmolality >100mmol/kg
- SIADH
Not dehydrated, no oedema and urine osmolality <100 mmol/kg
- water overload
- severe hypothyroidism
- gluco-corticoid insufficiency
What are the possible causes for hyperkalaemia?
oliguric renal failure
K sparing diuretics
rhabdomyolysis
metabolic acidosis - DM
excess K therapy
Addison’s disease
Massive blood transfusion
burns
Drugs - ACE-I, suxamethonium
Artefactual result
What are the possible causes for hypokalaemia?
With alkalosis
- thiazide and loop diuretics
- vomiting
- pyloric stenosis
- cushing’s syndrome/steroids/ACTH
- Conn’s syndrome
With acidosis
- diarrhoea
- renal tubular acidosis/failure
- acetazolamide
- partially treated diabetic ketoacidosis
- rectal villous adenoma
- intestinal fistula
Alkalosis
Purgative and liqourice abuse
Magnesium deficiency
What are the possible causes for hypercalcaemia?
Albumin raised:
- dehydration
- cuffed specimen
Albumin normal or low with decreased phosphate:
- primary or tertiary hyperparathyroidism
albumin normal/low, phosphate high/normal and alk phos high:
- bone mets
- sarcoidosis
- thyrotoxicosis
- lithium
albumin normal/low, phosphate high/normal and alk phos normal
- myeloma (incr plasma protein)
- vitamin D excess
- sarcoidosis
- milk-alkali syndrome (raised HCO3)
What are the causes of metastatic calcification (cause of hypercalcaemia)?
PARATTHORMONE
Parathyroid hormone levels incr and other causes of hypercalcaemia - sarcoidosis etc
Amyloidosis
Renal failure - relates to PO4
Addison’s disease - adrenal calc
TB nodes
Toxoplasmosis (CNS)
Histoplasmosis
Overdose of vitamin D
Raynaud’s associated diseases - SLE, CREST, dermatomyositis
Muscle primaries/leiomyosarcomas
Ossifying metastases (Osteosarcoma or ovarian mets)
Nephrocalcinosis
Endrocrine tumours - gastrinoma etc
What are the causes of hypocalcaemia?
with increased PO43-
- chronic kidney disease
- hypoparathyroidism
- pseudohypoparathyroidism
- acute rhabdomyolysis
- vitamin D deficiency
- hypomagnesaemia
With normal/low PO43-
- osteomalacia
- acute pancreatitis
- over-hydration
- respiratory alkalosis - total Ca normal but decreased ionised Ca due to increased pH -> symptomatic
